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FORM 4 (11-30-2010)

FORM 4 (11-30-2010)

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Published by: Josh Kwiatkowski on Jan 04, 2011
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Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives

Application for Tax Paid Transfer and Registration of Firearm

OMB No. 1140-0014 (11/30/2010)

ATF Control Number 2a. Transferee's Name and Address (Including tradename, if any) (See instruction 2)

Submit in Duplicate to: National Firearms Act Branch Bureau of Alcohol, Tobacco, Firearms and Explosives, P.O. Box 530298 Atlanta, GA 30353-0298 1. Type of Transfer (Check one) $5 $200 Submit with your application a check or money order for the appropriate amount made payable to the Bureau of Alcohol, Tobacco, Firearms and Explosives. Upon approval of this application, this office will acquire, affix and cancel the required "National Firearms Act" stamp for you. (See instructions 2h, 2i and 3.) 3d. Number, Street, City, State and Zip Code of Residence (or Firearms Business Premises) if Different from Item 3a.

2b. County 3a. Transferor's Name and Address (Including trade name, if any) (Executors: see instruction 2k)

3b. Transferor’s Telephone Number and Area Code 3c. If Applicable: Decedent's Name, Address, and Date of Death

The above-named and undersigned transferor hereby makes application as required by Section 5812 of the National Firearms Act to transfer and register the firearm described below to the transferee. 4. Description of Firearm (Complete items a through h) d. Model c. Caliber, a. Name and Address of Manufacturer and/or Importer of b. Type of Firearm (See Gauge or instruction 1c) Firearm Length e. Of Barrel: f. Overall: Size (Inches) (Specify) g. Serial Number

h. Additional Description or Data Appearing on Firearm (Attach additional sheet if necessary)

5. Transferee's Federal Firearms License (If any) (Give complete 15-digit number) (See instruction 2b) First 6 digits 2 digits 2 digits 5 digits

6. Transferee's Special (Occupational) Tax Status (If any) a. Employer Identification Number b. Class


Transferor's Federal Firearms License First 6 digits 2 digits

(If any) 2 digits 5 digits

(Give complete 15-digit number) (See instruction 2b)

8. Transferor's Special (Occupational) Tax Status (If any) b. Class a. Employer Identification Number

Under Penalties of Perjury, I Declare that I have examined this application, and to the best of my knowledge and belief it is true, correct and complete, and that the transfer of the described firearm to the transferee and receipt and possession of it by the transferee are not prohibited by the provisions of Chapter 44, Title 18, United States Code; Chapter 53, Title 26, United States Code; or Title VII of the Omnibus Crime Control and Safe Streets Act, as amended; or any provisions of State or local law.

9. Consent to Disclosure of Information to Transferee (See instruction 8). to the Above-Named Transferee . 10. Signature of Transferor (or authorized official)


(Circle one) Authorize ATF to Provide Information Relating to this Application 11. Name and Title of Authorized Official (Print or type) 12. Date

By authority of the Director, This Application has been Examined, and the Transfer and Registration of the Firearm Described herein and the Interstate Movement of that Firearm, when Applicable, to the Transferee are: Approved (with the following conditions, if any) Signature of Authorized ATF Official

The Space Below is for the use of the Bureau of Alcohol, Tobacco, Firearms and Explosives Stamp Denomination

Disapproved (For the following reasons) Date
ATF Form 4 (5320.4) Revised March 2006

Firearms and Explosives. of any change to the description of the firearm in Item 4. WV 25405. Tobacco. (See instruction 2d) 13. WV 25405. Bureau of Alcohol. Subject to a court order restraining you from harassing. WV 25405. I have no information that the receipt or possession of the firearm or device described in item 4 would be place the transferee in violation of State or local law. Bureau of Alcohol.S. or any depressant. UNDER PENALTIES OF PERJURY. Bureau of Alcohol.4) Revised March 2006 . Under 21 years of age? e. An unlawful user of or addicted to. the registrant shall notify the NFA Branch.C. Law Enforcement Certification (See instruction 2e) I certify that I am the chief law enforcement officer of the organization named below having jurisdiction in the area of residence of . ATF Form 4 (5320.C. marijuana. correct and complete. ( Signature and Title of Chief Law Enforcement Officer) (Organization and Street Address) (County) (Telephone Number) (Date) Important Information for Currently Registered Firearms If this registration document evidences the current registration of the firearm described on it. Martinsburg. 922(b) (4) and 27 CFR 478. stimulant. or by a person with a similar relationship with the victim. Interstate Movement: If the firearm identified in item 4 is a machinegun. The transferee shall give full details on a separate sheet for all “YES” answers. or guardian of the victim. and to the best of my knowledge and belief it is true. immediately upon becoming prohibited for guidance on the disposal of the firearm. Tobacco. Martinsburg. Been discharged from the armed forces under dishonorable conditions? c. 244 Needy Road. Firearms and Explosives. or destructive device. Charged by information or under indictment in any court for a crime punishable by imprisonment for a term exceeding one year? b. An alien who is illegally or unlawfully in the United States? d. short-barreled rifle. short-barreled shotgun. Firearms and Explosives. in writing. Proof of Registration: This approved application is the registrant’s proof of registration and it shall be made available to any ATF officer upon request. I declare that I have examined this application and the documents submitted in support thereof. Transferee’s Certification (See instruction 2e) I. Tobacco. WV 25405. 244 Needy Road. Photograph 15. 244 Needy Road. Firearms and Explosives. Martinsburg. Martinsburg. of any change to the address in Item 2a. Change of Address: Unless currently licensed under the Gun Control Act. the executor should contact the NFA Branch. § 922 from possessing a firearm. Been adjudicated mentally defective or been committed to a mental institution? d. Are You: Yes No 14. short-barreled rifle. parent. the registrant may be required by 18 U.S. in writing. I have no information indicating that the transferee will use the firearm or device (Name of Transferee) described on this application for other than lawful purposes. have a reasonable necessity to (Name of Transferee) possess the machinegun. A fugitive from justice? c. short-barreled shotgun. in writing. the registrant shall notify the NFA Branch.S.98). Persons Prohibited from Possessing Firearms: If the registrant becomes prohibited by 18 U. or destructive device described on this application for the following reason(s) and my possession of the device or weapon would be consistent with public safety (18 U. (Signature of Transferee) (Date) 17.C. Bureau of Alcohol.Transferee Information The following questions must be answered by any transferee who is not a Federal firearms licensee or government agency. Tobacco. or narcotic drug. Change of Description: The registrant shall notify the NFA Branch. even if the judge actually gave you a shorter sentence? b. please note the following information. . Restrictions on Possession: Any restriction (see approval block on face of form) on the possession of the firearm identified in item 4 continues with the further transfer of the firearm. Have You: Yes a. Renounced your United States citizenship? No e. 16. Been convicted in any court of a crime for which the judge could have imprisoned you for more than one year. stalking or the use or attempted use of physical force committed by a current threatening an intimate partner or child of such partner? or former spouse. Estate Procedures: For procedures regarding the transfer of firearms in an estate resulting from the death of the registrant identified in item 2a. § 922(a)(4) to obtain permission from ATF prior to any transportation in interstate or foreign commerce. Been convicted in any court of a misdemeanor crime of domestic violence? This includes any misdemeanor conviction involving f. or any other controlled substance? a. 244 Needy Road.

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